Some women undergoing breast reconstruction after mastectomy are suitable candidates for a latissimus dorsi breast reconstruction. This is an autologous (autogenic) procedure, in that it uses the patient's own muscle, skin and fat, the advantage being that the tissue of the flap is far less likely to be rejected and the incidence of infection is low.
Using a latissimus dorsi flap means that the breast will be soft and have the same suppleness as ordinary breast tissue. The flap reconstruction can suit women who have had chest muscle as well as breast tissue removed following mastectomy, or whose chest skin tissue has been damaged by radiation, leading to poor rates of healing, and cannot tolerate the insertion of a breast implant.
Women who have a fuller volume breast size but cannot have donor tissue grafted from the abdominal area, either because they are particularly slender and do not have enough abdominal tissue, or because they have abdominal scarring from previous operations, may have this operation recommended to them.
Where is the Latissimus Dorsi, and What is the Muscle Anatomy and Function
The illustration below shows the site of the latissimis dorsi muscle in red. There is a pair, one on each side of the spine. Each muscle is roughly triangular, emerges right down at the base of the spine and rises up and across the back with attachments to the anterior iliac crest, lower six thoracic vertebrae, the lumbar fascia, the supraspinal ligament, and the anterior aspect of the third and sometimes fourth lower ribs. There is occasional attachment to the scapula.
As the latissimus dorsi reaches up and over the scapula and along the lower border of the teres major muscle, it narrows and comes together as a tight band, or tendon, linking in to and helping to form the back of the axilla. Its insertion is at the point where the humerus fits into a shallow depression of bone (the glenoid fossa), stabilised by a protective covering of fibrous tissue which also acts as a connection point for other ligaments.
This muscle draws the shoulders and arms inwards (adduction) and downwards, and allows for internal extension and rotation of the humerus so that the arm can twist at the shoulder.
Latissimus Dorsi Breast Reconstruction
At the time of mastectomy every effort will be made to leave some breast skin to help form the shape of a new breast should reconstruction be considered a possibility.
During breast reconstruction an ellipse of skin and fat the size of the planned breast, together with some of the underlying muscle, is dissected away from the back. The blood supply is retained at the inner end of the flap, and the flap is then swung round in the opposite direction to the front of the chest to provide the muscle, fat and skin bulk to replace the original breast. As the main blood supply to the latissimus dorsi comes from the vessels in the armpit, this makes the use of this flap particularly useful for breast reconstructions.
Some women may want a breast implant at the same time, depending on the usual breast size and the amount of tissue available.
Following reconstruction, the flap site on the back will differ in shape to the other side since some muscle has been removed, and there will of course be scarring. The strength of the back and arm tends not to be compromised however, and the good results obtained with the flap reconstruction far outweigh any minor asymmetry.
The surgeon will also offer the opportunity for a nipple and areola to be constructed or tattooed onto the new breast about two to three months following the reconstruction.This allows time for swelling to subside and for the new breast to settle into its shape before the exact position of the new nipple is planned.
What is the Recommended Timescale for Breast Reconstruction?
Women will usually be advised to wait three to four months after mastectomy before undergoing breast reconstruction. The surgical shock of mastectomy and a major breast reconstruction, requiring long hours in theatre under anaesthetic, is usually considered too much for the body to cope with. The waiting time also gives women the chance to come to terms with the life change and to recover from the physically and emotionally draining stress of mastectomy, radiotherapy and chemotherapy.
Women considering breast reconstruction may also find the following articles of help and interest: What is a TRAM Flap Breast Reconstruction? and What is a DIEP Flap Breast Reconstruction?
Disclaimer: This article is intended as information only. Women should consult a plastic and reconstructive surgeon with extensive experience in breast reconstructions. Breast reconstruction after cancer treatment is available on the NHS and will be offered as part of the preparation for mastectomy.
Sources and recommended further reading
- macmillan.org.uk
- breakthrough.org.uk
- bapras.org.uk - The British Association of Plastic, Reconstructive and Aesthetic Surgeons
Suzanne Bosworth - Suzanne Bosworth BA (Hons) - a professional writer published in magazines, journals and websites, specialising in arts, history and ...
